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Angina Pectoris
Published in Charles Theisler, Adjuvant Medical Care, 2023
Angina pectoris is chest pain that occurs when the coronary blood supply is temporarily insufficient to meet the oxygen needs of the heart muscle (hypoxia). The pain can be accompanied by a feeling of heaviness or tightening in the chest. Angina is not a condition; it is a symptom of coronary heart disease or blocked arteries. Angina can also be a warning sign that there is an increased risk for a heart attack. Nitroglycerine is the primary medical treatment for angina.
Coronary Artery Disease
Published in Jahangir Moini, Matthew Adams, Anthony LoGalbo, Complications of Diabetes Mellitus, 2022
Jahangir Moini, Matthew Adams, Anthony LoGalbo
When a patient has chest discomfort caused by exertion and relieved by rest, the diagnosis of stable angina is likely. It is more accurate when significant risk factors for CAD are present. Patients are assessed for an acute coronary syndrome if their chest discomfort lasts for more than 20 minutes. It is important to understand that chest discomfort can also be caused by anxiety, panic attacks, costochondritis, GI disorders, and hyperventilation. ECG is performed, and for some cases, stress testing with ECG or myocardial imaging and coronary angiography may order. Myocardial imaging methods include echocardiography, MRI, and radionuclide imaging. The noninvasive tests are performed first.
Headache
Published in Philip B. Gorelick, Fernando D. Testai, Graeme J. Hankey, Joanna M. Wardlaw, Hankey's Clinical Neurology, 2020
Adverse effects of sumatriptan are common but are usually mild and short-lived. The most frequent are tingling, paresthesias, and warm sensations in the head, neck, chest, and limbs; less frequent are dizziness, flushing, and neck pain or stiffness. The risk and intensity is greater with the fixed subcutaneous formulation. “Chest-related symptoms” include short-lived heaviness or pressure in the arms and chest, shortness of breath, chest discomfort, anxiety, palpitations, and, very rarely, chest pain. The mechanism is unknown. The risk of sumatriptan-induced myocardial ischemia in the absence of coronary artery disease appears to be acceptable (e.g. no greater than the risk of exercise-induced myocardial ischemia in athletes).27
AMI in (bi)ventricular pacing – do not discard the ECG
Published in Acta Clinica Belgica, 2023
T. Versyck, D. Devriese, S. Smith, P. Calle, C. Borin
Chest pain is one of the most common symptoms among patients in the emergency department. The diagnosis of AMI relies initially on the patient’s medical history and risk factors, the anamnesis and the 12-lead ECG. However, in the presence of a pacemaker rhythm, the electrocardiographic diagnosis becomes difficult, but not impossible. There is a growing body of literature that suggests that Smith-modified Sgarbossa criteria can be applied for the diagnosis of STEMI in patients with paced rhythms. The Sgarbossa criteria were originally developed for the interpretation of ECGs in chest pain patients with a LBBB, but have been expanded to paced ECGs and optimized by Smith to increase sensitivity and specificity (Figure 1). We present three cases of chest pain patients with, respectively, right ventricular and biventricular pacing and delayed STEMI diagnosis.
Current evidence of COVID-19 vaccination-related cardiovascular events
Published in Postgraduate Medicine, 2023
Sajad Khiali, Afra Rezagholizadeh, Hossein Behzad, Hossein Bannazadeh Baghi, Taher Entezari-Maleki
Regarding male predominance in the development of myocarditis and pericarditis, a highly possible explanation relates to different main sex hormones and their effects on the heart and immune system; however, underdiagnosed heart conditions could be another reason for this rate difference [20]. The occurrence of myocarditis mainly following the second dose of vaccines could be due to a hypersensitivity phenomenon after receipt of the first dose as a sensitizing dose [20,34].Evidence shows that myocarditis/pericarditis symptoms following COVID-19 mRNA vaccine administration usually begin during seven days of vaccination ranging from 6 hours to several days in some case reports [22,34,35]. The predominant symptoms are chest pain which may be respiratory‐dependent, dyspnea, palpitation, chest discomfort, myalgia, sub-febrile to febrile temperatures, and fatigue. Clinically significant signs of COVID-19 vaccine-related myocarditis included elevated troponins (peak between 48–72 h after symptom onset), C-reactive protein elevation, minor pericardial effusion, and nonspecific electrocardiographic changes, such as mild diffuse ST-segment changes, PQ segment depressions, sinus tachycardia, and rarely supraventricular or ventricular arrhythmias. Cardiac troponin values were elevated up to 400 times higher than the normal level in myocarditis cases. On the contrary, pericarditis cases usually show normal cardiac troponin levels [20,35–42].
Cardiopulmonary exercise test-based assessment of the effects of sacubitril/valsartan on the blood pressure response to exercise in patients with acute myocardial infarction during hospitalization
Published in Clinical and Experimental Hypertension, 2022
Chun-Mei Zeng, Yan-Mei Zhao, Yi-Yi Li, Zhi-Hai Lin, Ping Li, Ying Feng, Jian-Ping Tan, Kai-Fang Pang
A total of 10 patients complained of shortness of breath during exercise, and two patients experienced chest tightness and chest pain. Premature ventricular beats occurred in 23 patients during exercise, and no malignant arrhythmias, such as ventricular tachycardia, were detected. The differences in the respiratory exchange rate, the score in dyspnea, the Borg score, positivity in the ECG, complaints of exercise discomfort, and premature ventricular contractions were not statistically significant between the two groups (P > .05 in all). However, the proportion of exercise oscillatory ventilation (EOV) was higher in the S/V group than in the perindopril group (10.8% vs 1.6%, X2= 11.148, P = .001), as is shown in Table 2.